INTEGRATION OF NURSING FALL II Review notes
Comprehensive Exam Study Notes for a Guarantee
1. What are the rights of delegation? - ANSWER- Right task: The task must be
appropriate for the scope of practice of the person you are delegating it to.
- Right circumstance: Is the patient stable enough for that person to do the
task?
- Right direction/communication: Nurse must provide clear and concise
instructions about the task.
- Right person: Nurse ensures that the person is competent enough to do that
(Like the person may say they know how, but you know they dumb) (like the
shitty tech that wont actually do anything) (or don't delegate to a tech that's
super busy)
- Right supervision and evaluation: Nurse must follow up on the task and
make sure it was done right.
2. What is the scope of practice? - ANSWER- The range of duties and
responsibilities that the healthcare person is authorized to do based on
education, training, license, and regulations.
3. What is Maslow's hierarchy of needs? - ANSWERThe 5 tier pyramid. Each
basic need must be fulfilled before the next. It helps prioritize patient care.
- Physiological needs: Like airway, breathing, circulation, managing pain,
providing food and water, helping with elimination needs.
- Safety needs: Like fall precautions, hand hygiene, admin medications right,
addressing fears and anxiety about treatment
,- Love and belonging: Encourage family visits, social interaction, emotional
support, listening to their concerns, helping them get into support groups
- Esteem: Respecting patients' dignity, promoting independence, etc.
- Self-actualization: Supporting patient goals, encouraging activities that fulfill
their potential, and respecting their beliefs and values
4. What is the nurse's role in disaster drills? - ANSWER- Planning and
coordination: Participate in development of disaster response plans and
coordinating with other healthcare professionals to establish clear roles and
responsibilities.
- Education and training: Educating and training staff on disaster protocols
including evacuation procedures, triage, and use of emergency equipment.
- Triage and patient care: Practicing triage techniques to prioritize patient
care based on the severity of their conditions. Make sure everyone is familiar
with the procedure and management of large numbers of patients in crisis
situations.
- Resource management: Make sure supplies and equipment needed is there.
Like PPE, meds, etc.
- Communication: Make sure you are effectively communicating with the
other staff members and departments. Document actions and patient
information to ensure continuity of care and the right response.
- Evaluation and feedback: Participate in debriefing sessions after drills to
evaluate performance and identify strengths and weaknesses. Revising and
updating disaster response plans as needed.
5. What is the disaster triage color system? - ANSWERIt helps prioritize those
who need immediate care during a time when there is limited resources
during a disaster.
, 1st RED: Patient with life threatening injury or condition that requires
immediate intervention. Example: Severe bleeding, major burn, airway
obstruction, shock, or severe respiratory distress
2nd YELLOW: Patients who have serious injuries that require medical
attention but not immediately life threatening. Treatment can be delayed
without affecting their chance of survival. Example: Stable fractures,
moderate burns, or wounds that require medical care but not critical.
3rd GREEN: Patients with minor injuries or illnesses who do not require
immediate medical attention. They are the "walking wounded". Examples:
Minor cutes, bruises, or sprains. Like they won't die if you don't see them in
the next 2 hours.
4th BLACK: These patients do not need you anymore. They dying with your
intervention anyway. Example: Cardiac arrest, catastrophic head injuries,
severe trauma with no vital signs.
6. What are the components of the primary survey? - ANSWERUsed to
quickly assess and manage life threatening conditions on patients. Use the
ABCDE approach with this.
A: Ariway and cervical spine protection: Make sure airway is open and clear
and protect the spine if trauma is suspected
B: Breathing: Assess and ensure they have adequtes breathing and
ventilation. (See if they are breathing)
C: Circulation: Check for a pulse, blood pressure, and control any bleeding.
D: Disability (Neurological status): Assess LOC.
E: Exposure: Fully expose the patient to identify hidden injuries or conditions.
7. What are components of the secondary survey? - ANSWERF: Full set of
vital signs
G: Get necessary adjuncts: Like labs, scans, etc
Comprehensive Exam Study Notes for a Guarantee
1. What are the rights of delegation? - ANSWER- Right task: The task must be
appropriate for the scope of practice of the person you are delegating it to.
- Right circumstance: Is the patient stable enough for that person to do the
task?
- Right direction/communication: Nurse must provide clear and concise
instructions about the task.
- Right person: Nurse ensures that the person is competent enough to do that
(Like the person may say they know how, but you know they dumb) (like the
shitty tech that wont actually do anything) (or don't delegate to a tech that's
super busy)
- Right supervision and evaluation: Nurse must follow up on the task and
make sure it was done right.
2. What is the scope of practice? - ANSWER- The range of duties and
responsibilities that the healthcare person is authorized to do based on
education, training, license, and regulations.
3. What is Maslow's hierarchy of needs? - ANSWERThe 5 tier pyramid. Each
basic need must be fulfilled before the next. It helps prioritize patient care.
- Physiological needs: Like airway, breathing, circulation, managing pain,
providing food and water, helping with elimination needs.
- Safety needs: Like fall precautions, hand hygiene, admin medications right,
addressing fears and anxiety about treatment
,- Love and belonging: Encourage family visits, social interaction, emotional
support, listening to their concerns, helping them get into support groups
- Esteem: Respecting patients' dignity, promoting independence, etc.
- Self-actualization: Supporting patient goals, encouraging activities that fulfill
their potential, and respecting their beliefs and values
4. What is the nurse's role in disaster drills? - ANSWER- Planning and
coordination: Participate in development of disaster response plans and
coordinating with other healthcare professionals to establish clear roles and
responsibilities.
- Education and training: Educating and training staff on disaster protocols
including evacuation procedures, triage, and use of emergency equipment.
- Triage and patient care: Practicing triage techniques to prioritize patient
care based on the severity of their conditions. Make sure everyone is familiar
with the procedure and management of large numbers of patients in crisis
situations.
- Resource management: Make sure supplies and equipment needed is there.
Like PPE, meds, etc.
- Communication: Make sure you are effectively communicating with the
other staff members and departments. Document actions and patient
information to ensure continuity of care and the right response.
- Evaluation and feedback: Participate in debriefing sessions after drills to
evaluate performance and identify strengths and weaknesses. Revising and
updating disaster response plans as needed.
5. What is the disaster triage color system? - ANSWERIt helps prioritize those
who need immediate care during a time when there is limited resources
during a disaster.
, 1st RED: Patient with life threatening injury or condition that requires
immediate intervention. Example: Severe bleeding, major burn, airway
obstruction, shock, or severe respiratory distress
2nd YELLOW: Patients who have serious injuries that require medical
attention but not immediately life threatening. Treatment can be delayed
without affecting their chance of survival. Example: Stable fractures,
moderate burns, or wounds that require medical care but not critical.
3rd GREEN: Patients with minor injuries or illnesses who do not require
immediate medical attention. They are the "walking wounded". Examples:
Minor cutes, bruises, or sprains. Like they won't die if you don't see them in
the next 2 hours.
4th BLACK: These patients do not need you anymore. They dying with your
intervention anyway. Example: Cardiac arrest, catastrophic head injuries,
severe trauma with no vital signs.
6. What are the components of the primary survey? - ANSWERUsed to
quickly assess and manage life threatening conditions on patients. Use the
ABCDE approach with this.
A: Ariway and cervical spine protection: Make sure airway is open and clear
and protect the spine if trauma is suspected
B: Breathing: Assess and ensure they have adequtes breathing and
ventilation. (See if they are breathing)
C: Circulation: Check for a pulse, blood pressure, and control any bleeding.
D: Disability (Neurological status): Assess LOC.
E: Exposure: Fully expose the patient to identify hidden injuries or conditions.
7. What are components of the secondary survey? - ANSWERF: Full set of
vital signs
G: Get necessary adjuncts: Like labs, scans, etc
